Pencole Lucile, Peyronnet Violaine, Mandelbrot Laurent, Lepercq Jacques
Maternité Hôpital Louis Mourier, Colombes, France; AP-HP, France; FHU PREMA, F-75014 Paris, France; Université de Paris, F-75006 Paris, France.
AP-HP, France; FHU PREMA, F-75014 Paris, France; Université de Paris, F-75006 Paris, France; Maternité Port-Royal, Hôpital Cochin, Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2021 May;260:118-123. doi: 10.1016/j.ejogrb.2021.03.028. Epub 2021 Mar 19.
the main objective was to identify risk factors of relaparotomy for intra-abdominal hemorrhage (IAH) after cesarean delivery. The secondary objectives were to identify clinical warning signs associated with IAH: heart rate>120/min, systolic blood pressure<90 mmHg, scar bleeding, unconsciousness or abdominal pain with visual analog pain scale > 7 or use of category 3 analgesic medications, in the post-anesthesia care unit and in the post-partum unit.
a case-control study (1:2 ratio), in two academic tertiary perinatal centers during 2008-2017. Postpartum laparotomies performed for another indication were excluded. The cases were women who underwent relaparotomy for IAH. A control group comprised women who had an uncomplicated cesarean delivery before and after each case.
19,007 women had a cesarean delivery during the study period and among them 52 relaparotomies (0.27 %) for IAH were performed. 48 cases were compared to 96 controls. In multivariate analysis, the existence of a preeclampsia (aOR = 2.8, 95 % IC 1.1-7.4), urgent cesarean (aOR = 3.2, 95 % IC 1.1-9.6), surgical difficulties during initial cesarean (aOR = 9.0, 95 % IC 2.8-23.8), and estimated blood loss > 500 mL during initial cesarean (aOR = 7.4, 95 % IC 2.4-22.5) were independently associated with IAH. Tachycardia > 120/min was the most discriminating factor associated with the occurrence of relaparotomy for IAH (84 %). In the absence of tachycardia, hypotension < 90 mmHg was the second most discriminant factor for IAH (73 %).
preeclampsia, urgent cesarean, surgical difficulties and blood loss > 500 mL during initial cesarean were independently associated with an increased risk of relaparotomy for IAH. Tachycardia and/or hypotension were discriminant-warning signs for severe IAH.
主要目的是确定剖宫产术后腹腔内出血（IAH）再次剖腹手术的风险因素。次要目的是确定与IAH相关的临床警示体征：在麻醉后护理单元和产后单元中，心率>120次/分钟、收缩压<90 mmHg、切口出血、意识丧失或视觉模拟疼痛量表评分>7的腹痛或使用3类镇痛药物。
一项病例对照研究（1:2比例），于2008年至2017年在两个学术性三级围产期中心进行。排除因其他指征进行的产后剖腹手术。病例为因IAH接受再次剖腹手术的女性。对照组包括在每个病例前后进行无并发症剖宫产的女性。
在研究期间，19007名女性进行了剖宫产，其中52例（0.27%）因IAH进行了再次剖腹手术。将48例病例与96例对照进行比较。多因素分析显示，子痫前期（调整后比值比[aOR]=2.8，95%可信区间[IC]1.1-7.4）、急诊剖宫产（aOR=3.2，95%IC 1.1-9.6）、初次剖宫产时手术困难（aOR=9.0，95%IC 2.8-23.8）以及初次剖宫产时估计失血量>500 mL（aOR=7.4，95%IC 2.4-22.5）与IAH独立相关。心率>120次/分钟是与IAH再次剖腹手术发生相关的最具鉴别性的因素（84%）。在无心动过速的情况下，收缩压<90 mmHg是IAH的第二大鉴别性因素（73%）。
子痫前期、急诊剖宫产、手术困难以及初次剖宫产时失血量>500 mL与IAH再次剖腹手术风险增加独立相关。心动过速和/或低血压是严重IAH的鉴别性警示体征。
